Investigation of dermatological manifestations in maintenance hemodialysis patients

Aims: Skin findings are common in patients with both chronic kidney disease and undergoing hemodialysis. These findings are observed as nonspecific and specific dermatological manifestations. Our study aimed to describe the characteristics of dermatologic findings of patients with end-stage renal disease undergoing maintenance hemodialysis treatment and to investigate the relationship between these findings and the demographic and clinical features of those patients. Methods: Patients who were admitted to a private hemodialysis clinic in August 2023 were prospectively analyzed. Age, gender, type of vascular access, hemodialysis duration, etiology of end-stage renal disease, duration and frequency of hemodialysis sessions, dermatological findings, and the most recent complete blood count, parathyroid hormone, calcium, phosphorus, urea, and creatinine levels were examined and the findings were documented. Calcium x phosphorus levels were calculated. Statistical significance was accepted as p<0.05. Results: A total of 43 patients with chronic kidney disease undergoing maintenance hemodialysis were included in the study. 23 (53.5%) of the patients were female and 20 (46.5%) were male. The ages of the patients ranged from 28 to 86 years (mean age: 62.79±12.63). Xerosis was the most common dermatological finding with a rate of 90.7%. Hyperpigmentation was found in 46.5%, pruritus in 41.9%, nail disorders (subungual hyperkeratosis, absent lunula, koilonychia, half and half nail, onychorrhexis) in 37.2%, pallor in 30.2% and ecchymosis in 14%. In addition, 55.8% of the patients had mucosal changes (mucosal pallor, xerostomia, oral candidiasis, black hairy tongue, burning mouth), and 27.9% had hair findings (lusterless hair, sparse hair, telogen effluvium). Pruritus was more frequent in patients with higher predialysis urea levels (173.27±49.75 mg/dl vs. 137.04±38.19 mg/dl), (p<0.011). Xerosis and hair findings were more common in women (100% vs. 80%, 92% vs. 0%), (p<0.039, p<0.001). Hyperpigmentation was found more frequently in patients with long-term hemodialysis duration (median: 6.50 years vs. 2.00 years), (p<0.003). Conclusion: Dermatologic findings are frequently observed in patients under maintenance hemodialysis treatment and may have a negative impact on quality of life. Therefore, dermatologic evaluation should be considered an essential part of treatment in patients under maintenance hemodialysis.

Keywords:

skin findings hemodialysis, chronic kidney disease,

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Kidney Disease Improving Global Outcomes (KDIGO). KDIGO 2023 Clinical practice guideline for the evaluation and management of chronic kidney disease. Available at: https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2023-CKD-Guideline-Public-Review-Draft_5-July-2023.pdf. Accessed 11.09.2023.
Goel V, Sil A, Das A. Cutaneous manifestations of chronic kidney disease, dialysis and post-renal transplant: a review. Indian J Dermatol. 2021:66(1):3-11.
Robles-Mendez JC, Vazquez-Martinez O, Ocampo-Candiani J. Skin manifestations of chronic kidney disease. Actas Dermosifiliogr. 2015;106(8):609-622.
Picó MR, Lugo-Somolinos A, Sánchez JL, Burgos-Calderón R. Cutaneous alterations in patients with chronic renal failure. Int J Dermatol. 1992;31(12):860-863.
Bencini PL, Montagnino G, Citterio A, Graziani G, Crosti C, Ponticelli C. Cutaneous abnormalities in uremic patients. Nephron. 1985;40(3):316-321.
Specchio F, Carboni I, Chimenti S, Tamburi F, Nistico' S. Cutaneous manifestations in patients with chronic renal failure on hemodialysis. Int J Immunopathol Pharmacol. 2014;27(1):1-4.
Kelkar MB, Kote R, Gugle AS, Pawar M, Kumawat S. An observational study of dermatological manifestations in patients of chronic renal failure undergoing hemodialysis. MVP J Med Sci. 2019; 6(2):120-125.
Falodun O, Ogunbiyi A, Salako B, George AK. Skin changes in patients with chronic renal failure. Saudi J Kidney Dis Transpl. 2011;22(2):268-272.
Thomas EA, Pawar B, Thomas A. A prospective study of cutaneous abnormalities in patients with chronic kidney disease. Indian J Nephrol. 2012;22(2):116-120.
Udayakumar P, Balasubramanian S, Ramalingam KS, Lakshmi C, Srinivas CR, Mathew AC. Cutaneous manifestations in patients with chronic renal failure on hemodialysis. Indian J Dermatol Venereol Leprol. 2006;72(2):119-125.
Mourad B, Hegab D, Okasha K, Rizk S. Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt. Clin Cosmet Investig Dermatol. 2014;7:313-319.
Dahbi N, Hocar O, Akhdari N, et al. Manifestations cutanées chez les hémodialysés chroniques [cutaneous manifestations in hemodialysis patients]. Nephrol Ther. 2014;10(2):101-105. French.
Asayesh H, Peykari N, Pavaresh-Masoud M, et al. Dermatological manifestations in hemodialysis patients in Iran: a systematic review and meta-analysis. J Cosmet Dermatol. 2019;18(1):204-211.
Onelmis H, Sener S, Sasmaz S, Ozer A. Cutaneous changes in patients with chronic renal failure on hemodialysis. Cutan Ocul Toxicol. 2012;31(4):286-291.
Güder S, Karaca Ş, Kulaç M, Yüksel Ş, Güder H. Afyonkarahisar ve çevresinde diyalize giren kronik böbrek yetmezlikli hastalardaki deri bulguları. Türkderm- Deri hastalıkları ve Frengi Arşivi. 2012:181-185.
Abdelbaqi-Salhab M, Shalhub S, Morgan MB. A current review of the cutaneous manifestations of renal disease. J Cutan Pathol. 2003;30:527–538.
Momose A, Kudo S, Sato M, et al. Calcium ions are abnormally distributed in the skin of haemodialysis patients with uraemic pruritus. Nephrol Dial Transplant. 2004;19(8):2061-2066.
Peres LA, Passarini SR, Branco MF, Kruger LA. Dermatoses em renais cronicos em terapia dialitica [Skin lesions in chronic renal dialysis]. J Bras Nefrol. 2014;36(1):42-47.
Öztürk P, Dokur N, Kurutaş E, et al. Hemodiyaliz tedavisi alan kronik böbrek yetmezlikli hastalarda tırnak bulgularının incelenmesi. Turk J Dermatol. 2012;6(2):35-38.
Dembowska E, Jaroń A, Gabrysz-Trybek E, Bladowska J, Trybek G. Oral mucosa status in patients with end-stage chronic kidney disease undergoing hemodialysis. Int J Environ Res Public Health. 2023;20(1):835.
Castillo A, Mesa F, Liébana J, et al. Periodontal and oral microbiological status of an adult population undergoing haemodialysis: a cross-sectional study. Oral Dis. 2007;13(2):198-205.